Mary P. Gallant

The Influence of Social Support on Chronic Illness Self-Management: A Review and Directions for Research:

A review of the empirical literature examining the relationship between social support and chronic illness self-management identified 29 articles, of which 22 were quantitative and 7 were qualitative. The majority of research in this area concerns diabetes self-management, with a few studies examining asthma, heart disease, and epilepsy management. Taken together, these studies provide evidence for a modest positive relationship between social support and chronic illness self-management, especially for diabetes. Dietary behavior appears to be particularly susceptible to social influences. In addition, social network members have potentially important negative influences on self-management. There is a need to elucidate the underlying mechanisms by which support influences self-management and to examine whether this relationship varies by illness, type of support, and behavior. There is also a need to understand how the social environment may influence self-management in ways other than the provision of social support.

The costs of caring: impact of dementia on family caregivers.

With the aging of the population, an increasing number of older adults are diagnosed with Alzheimers disease or a related disorder. Most people with a dementing illness will be cared for at home by a family member, who may experi ence a variety of physical, emotional, financial, and social burdens associated with the caregiving role. The purpose of this article is to (a) examine the physical and psychological effects of providing care to a family member with a dement ing illness, (b) describe the factors that help determine the nature and magnitude of these effects, and (c) discuss several approaches to caregiver intervention designed to reduce the negative impact of this challenging role. Sociodemographic characteristics (e.g., gender, relationship to the patient, culture, race, ethnicity), caregiver resources (e.g., coping, social support, availability of a companion animal), and personal characteristics (e.g., personality, health behaviors) shape the dementia caregiving experience and have implications for interventions designed to prevent or lessen the stress and burden that often accompany the role. (J Geriatr Psychiatry Neurol 2001; 179-187).

Predictors of decreased self-care among spouse caregivers of older adults with dementing illnesses.

This study describes the health behaviors (alcohol consumption, exercise, sleep patterns, smoking, and weight maintenance) of a sample of older adult spouse caregivers (N = 233) and investigates the predictors of decreased self-care since caregiving began. Multiple regression results indicate that caregivers who experience greater developmental burden, report a greater number of depressive symptoms, perform a greater number of activities of daily living (ADL) tasks in caregiving and spend more hours in a day providing care, and who have lower self-efficacy for both self-care and spouse care are at greater risk for negative health behavior change. Results have implications for the identification of caregivers who may be particularly vulnerable to the negative health impact of caregiving.

Help or Hindrance? How Family and Friends Influence Chronic Illness Self-Management among Older Adults

We contribute to knowledge about older adults with chronic illnesses by identifying positive and negative influences of family and friends on self-management. Thirteen focus groups were conducted in upstate New York with 84 African American and White men and women, 65 years old or older, with arthritis, diabetes, and/or heart disease. Specific positive and negative social network influences are discussed in the areas of disease management (medication management, dietary activities, physical activity, and health care appointments); decision-making about the illness; and psychosocial coping. Overall, we found many more positive than negative social network influences, and more negative influences from family members than from friends. We discuss differences between influences of family members versus friends, and point out a few suggestive differences by gender and race. We conclude with limitations of the study as well as implications for the design of self-management interventions involving family members and friends.

The Stress Process among Dementia Spouse Caregivers: Are Caregivers at Risk for Negative Health Behavior Change?

This study examines the relationship between the demands of providing care to a spouse with dementia and caregiver health behaviors, specifically exercise, sleep patterns, weight maintenance, smoking, and alcohol consumption. Structural equation modeling was used to test a model predicting health behavior change from personal and environmental characteristics, perceived stress, social support, and depressive symptoms in a sample of 233 spouse caregivers of dementia patients and to examine gender differences in these relationships. Results support the hypothesis that caregiving negatively influences health behaviors. Among both women and men, health behavior change is directly influenced by depressive symptoms and objective burden. In addition, depressive symptoms mediate the effects of self-efficacy and objective burden on health behavior change. These results support the notion that health behavior change may represent one mechanism by which caregiving stress leads to adverse health outcomes.

Chronic Illness Self-care and the Family Lives of Older Adults: A Synthetic Review Across Four Ethnic Groups

The purpose of this paper is to integrate the literature on family and social ties among older ethnic minority men and women with the literature on chronic illness self-care among elders in these groups, in order to increase understanding of social influences on self-care behavior, raise questions for future research, and inform culturally appropriate interventions to maximize the health-promoting potential of social relationships. The paper presents demographic and chronic illness prevalence information, and then summarizes literature about patterns of chronic illness self-care behaviors for older African-Americans, Latinos, Asian-Americans, and American Indians in the U.S. For each group, the sociological literature about residential, cultural, and socioeconomic patterns, family lives, and other social ties is then reviewed, and the self-care literature that has accounted for these patterns is discussed. Finally, six themes are outlined and related questions are identified to further illuminate the social context of older adults’ chronic illness self-care.

Making Healthy Behaviors the Easy Choice for Employees: A Review of the Literature on Environmental and Policy Changes in Worksite Health Promotion

As employers look for ways to reduce rising health care costs, worksite health promotion interventions are increasingly being used to improve employee health behaviors. An alternative approach to traditional worksite health promotion programs is the implementation of environmental and/or policy changes to encourage employees to adopt healthier behaviors. This review examines the evidence for the effectiveness of worksite health promotion programs using environmental and/or policy changes either alone or in combination with individually focused health behavior change strategies. A review of the relevant literature, published between 1995 and 2010, identified 27 studies that met all inclusion criteria. Limited evidence was found for the effectiveness of environmental and/or policy changes alone (n = 11) to change employee behavior, but more promising results were identified with multicomponent interventions (n = 16). There is a strong need for improvement in the design and evaluation of future health promotion programs focusing solely on environmental and/or policy changes at the worksite.

Medication‐taking among adult renal transplant recipients: barriers and strategies

Medication adherence is essential for the survival of kidney grafts, however, the complexity of the medication‐taking regimen makes adherence difficult. Little is known about barriers to medication‐taking and strategies to foster medication‐taking. This cross‐sectional study involved semi‐structured interviews with 82 kidney transplant recipients approximately 2 months post‐transplant on medication‐related adherence, barriers to medication‐taking, and strategies to foster medication‐taking. Although self‐reported adherence was high (88%), qualitative analysis revealed that half of the patients (49%) reported experiencing at least one barrier to medication‐taking. The most common barriers were: not remembering to refill prescriptions (13%), changes to medication prescriptions or dosages (13%), being busy (10%), forgetting to bring medicines with them (10%), and being away from home (10%). The most common strategies to foster medication‐taking were: maintaining a schedule of medication‐taking (60%), organizing pills using pillboxes, baggies, cups (42%), bringing medicines with them (34%), organizing pills according to routine times (32%), and relying on other people to remind them (26%). Understanding the range of barriers to adherence and strategies kidney recipients devised to promote medication‐taking may help transplant clinicians to better educate transplant recipients about appropriate medication‐taking, mitigate the risk of medication nonadherence‐related rejection, and may help inform patient‐centered interventions to improve medication adherence.

Assessing sources of support for diabetes self-care in urban and rural underserved communities.

The ability of adults with diabetes to manage their illness properly and prevent complications is, in part, a function of support provided by the people and institutions surrounding them. Using data from over 200 adults with diabetes in two medically underserved communities – one urban and one rural – this study examines the self-care specific support provided by four key sources: family and friends, community organizations, one’s neighbors and neighborhood, and resources in the wider community. More specifically, this study aims to assess the support needs of adults with diabetes in these communities by estimating their rates of various self-care behaviors, the amount of support provided by key sources, and the associations between support from these sources and adherence to recommended diabetes self-care behaviors. Descriptive findings indicate that close to 40% of the sample failed to report at least moderate levels of adherence, and that physical activity in the rural community, and smoking in the urban community represent particular problem areas. Individuals from the urban subsample reported receiving more support from all of the sources assessed. Logistic regression models indicated that one’s neighbors and neighborhood resources appear to have a broad influence on adherence to diabetes self-care behaviors. Support from family and friends, as well as from community organizations, also seems to be important. These results have implications for the design of interventions aimed at bolstering support for diabetes self-care, and point to the need for an enhanced focus on strengthening the social environmental resources of adults with diabetes.

“The Bitter With the Sweet” Older Adults’ Strategies for Handling Ambivalence in Relations With Their Adult Children

This research adds to recent discussions of intergenerational ambivalence by analyzing accounts of relations with adult children from focus group interviews with older parents. When discussing their adult children, participants reveal strong desires for both autonomy and connection, leading to ambivalence about receiving assistance from them. They define themselves as independent but hope that children’s help will be available if needed. They are annoyed by children’s over protectiveness but appreciate the concern it expresses. They use a variety of strategies to deal with their ambivalent feelings, such as minimizing the help they receive, ignoring or resisting children’s attempts to control, withholding information from children to maintain clear boundaries, seeking others as confidants, and rationalizing children’s unavailability. They actively strive for a balance in their relationships with children. The authors interpret their findings in relation to their children’s styles of offering help and discuss implications for practitioners.